Spinal Hardware Block

Question:

How is a spinal hardware block coded?

Answer:

There is not a specific CPT code for a spinal hardware block.  Use an unlisted code 64999. When reporting an unlisted code to describe a procedure or service, it is necessary to submit supporting documentation with the claim to provide an adequate description of the nature, extent, and necessity for the procedure; and the time, effort, and equipment necessary to provide the service.

*This response is based on the best information available as of 03/15/18.

Placement of Lumbar Subarachnoid Drain

Question:

My neurosurgeon states he placed a subarachnoid drain in the lumbar spine after a craniotomy for CSF leak repair procedure. He thinks the correct code is 62350.  Is this accurate?

Answer:

No.  You’ll use 62272 (Spinal puncture, therapeutic, for drainage of cerebrospinal fluid (by needle or catheter) instead.  CPT 62350 is for placement of a catheter for long-term medical administration such as that necessary for a spinal pump; it is not the correct code for a lumbar drain.

*This response is based on the best information available as of 03/15/18.

Removal of Tympanostomy Tube

Question:

What is the code for removal of a tympanostomy tube when it was placed by another physician?  I can’t seem to find it in the CPT book anymore.

Answer:

Oh my goodness – that code describe was revised in 2003!  CPT 69424 now states: Ventilating tube removal requiring general anesthesia.  If the tube is removed under local, or no, anesthesia then it is included in your E/M service and not separately coded.

Please come quickly to an upcoming KZA coding course!Here are the dates and locations.

*This response is based on the best information available as of 03/15/18.

Fat Grafting with a Breast Revision

Question:

My doctor reports a breast revision with CPT codes 19380 and 20926 on the same breast.  Can we report the fat graft harvest in addition to the revision?

Answer:

CPT code 19380, Revision of reconstructed breast involves revising an already reconstructed breast. The code includes repositioning the breast; making adjustments to the inframammary crease; making capsular adjustments; and performing scar revisions, fat grafting, liposuction, and so on. Therefore, it is not appropriate to report the fat graft harvest with CPT 20926 as it is included in the procedure.

*This response is based on the best information available as of 03/15/18.

Denials of 30930 with 30140

Question:

We are getting denials when billing 30930 (outfracture of inferior turbinates) with 30140 (submucous resection of inferior turbinate). Do you know how we can get paid?

Answer:

Actually, it is not accurate to use both codes together for procedures on the same turbinate. CPT guidelines clearly state that 30930 (and 30801, 30802) are included in 30140 and should not be separately coded.  So, no, we cannot help you get paid but we can help you stay out of trouble by advising you not to report 30930 with 30140.

*This response is based on the best information available as of 03/01/18.

Multiple Lesion Excisions. Do you add them together?

Question:

If I am excising multiple basal cell carcinomas on a patient’s chest, do I add the sizes and margins together and report one code since they are in the same anatomic group of CPT codes?

Answer:

No.  For lesion excisions, each lesion plus it’s most narrow margin are reported separately.  CPT guidelines state to “report separately each malignant lesion excised.”  Remember, simple closure is bundled into lesion excision, but you would separately report intermediate or complex repairs.  And, depending on the type of repairs performed, you may need to add the repairs together.

*This response is based on the best information available as of 03/01/18.